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Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305).

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This study demonstrates that a submicrofeatured titanium surface created by a combination of sandblasting and anodic oxidation enhances the strength of early-stage osseointegration, primarily because of the increased resistance of peri-implant bone tissue against external force rather than modulation of bone morphogenesis.

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Abstract:The mechanism by which hydroxyapatite (HA)-coated titanium promotes bone-implant integration is largely unknown. Furthermore, refining the fabrication of nanostructured HA to the level applicable to the mass production process for titanium implants is challenging. This study reports successful creation of nanopolymorphic crystalline HA on microroughened titanium surfaces using a combination of flame spray and low-temperature calcination and tests its biological capability to enhance bone-implant integration. Sandblasted microroughened titanium implants and sandblasted + HA-coated titanium implants were subjected to biomechanical and histomorphometric analyses in a rat model. The HA was 55% crystallized and consisted of nanoscale needle-like architectures developed in various diameters, lengths, and orientations, which resulted in a 70% increase in surface area compared to noncoated microroughened surfaces. The HA was free from impurity contaminants, with a calcium/phosphorus ratio of 1.66 being equivalent to that of stoichiometric HA. As compared to microroughened implants, HA-coated implants increased the strength of bone-implant integration consistently at both early and late stages of healing. HA-coated implants showed an increased percentage of bone-implant contact and bone volume within 50 µm proximity of the implant surface, as well as a remarkably reduced percentage of soft tissue intervention between bone and the implant surface. In contrast, bone volume outside the 50 µm border was lower around HA-coated implants. Thus, this study demonstrated that the addition of pure nanopolymorphic crystalline HA to microroughened titanium not only accelerates but also enhances the level of bone-implant integration and identified the specific tissue morphogenesis parameters modulated by HA coating. In particular, the nanocrystalline HA was proven to be drastic in increasing osteoconductivity and inhibiting soft tissue infiltration, but the effect was limited to the immediate microenvironment surrounding the implant.

Background: Cardiac allograft vasculopathy (CAV) is typically characterized by concentric intimal thickening diffusely distributed throughout the coronary arterial tree. This study aimed to test the hypothesis that the accuracy of CAV assessment by IVUS is maintained at wider measurement intervals than the standard 1-mm intervals used for the analysis of atherosclerotic lesions. Methods: In 20 heart transplant recipients, baseline (4-6 weeks post-transplant) and 1-year IVUS were analyzed at 1-mm, 2-mm and 3-mm intervals in the first 50 mm of the LAD artery. 2D IVUS indices, including maximum intimal thickness (MIT), minimum lumen area (MLA) and maximum plaque burden (Max PB), were also determined based on the volumetric datasets. The measurements obtained at 1-mm intervals were used as a gold standard. Results: At baseline, both volumetric and 2D indices were comparable at 1-mm and 2-mm intervals, and statistically significant differences were only observed with at least 3-mm intervals for vessel and lumen volumes (p< 0.01), MIT (p< 0.05) and MLA (p< 0.05). At 1 year, volumetric IVUS indices did not differ significantly among the three intervals. On the other hand, both 2-mm and 3-mm intervals showed statistically significant differences in MIT, MLA and Max PB from 1-mm intervals (Figure). Conclusions: The diffuse nature of CAV appears to allow simple volumetric assessment at wider measurement intervals. However, 2D IVUS indices, reflecting the worst site and proven to predict long-term outcomes, are likely best captured by the standard 1-mm intervals established for the analysis of atherosclerosis.